KIDNEY

What is a stone?
A ureteral stone is a kidney stone that has left the kidney and moved down into the ureter. The stone begins as a tiny grain of undissolved material located where urine collects in the kidney. The material deposited is usually a mineral called calcium oxalate; there are other, less common, materials Over time, more and more undissolved material is deposited, and the stone progressively becomes larger. Some stones, by the time they leave the kidney, have grown too large to pass through the entire ureter. Such stones may become lodged in a narrow part of the ureter, causing pain and possibly blocking the flow of urine. These stones may need to be treated.

What are the signs?
Usually, the initial symptom of a kidney stone is one of extreme pain, described by some as being worse than that associated with childbirth. The pain often begins suddenly, when the stone moves within the kidney or ureter and causes irritation or blockage. Typically, a person feels a sharp, cramping pain in the back or side, the region of the body where the kidney is located. In some cases, the pain may radiate to the lower abdomen or groin. Oftentimes, blood in the urine and nausea and vomiting will accompany the pain, too.

There are some situations when stones do not produce any obvious symptoms. However, although the stones may be “silent,” they can still be growing, and may even threaten irreversible damage to kidney function.

In a man, pain may move down to the tip of the penis. If the stone is close to the lower end of the ureter at the opening into the bladder, a person will frequently feel like they have not fully completed urination.

How are stones diagnosed?
Sometimes “silent” stones, those that cause no symptoms are found on X-rays taken during a general health exam.

If your doctor suspects a stone but is unable to make a diagnosis from a simple X-ray, he or she may scan the urinary system with computed tomography (CT) or intravenous pyelography (IVP). IVP is an imaging technique that utilizes radiopaque injections of dye followed, during excretion by the kidneys, by abdominal X-rays.

A kidney obstructed by a stone will not be able to excrete the dye as quickly and may also appear enlarged when compared to the normal, unobstructed kidney. In many hospitals the IVP has been replaced by a CT scan, which is an extremely rapid and accurate diagnostic tool, which will detect almost all types of ureteral stones.

What are some treatment options?
Treating kidney stone disease depends largely on the size, position and number of stones that are present. Te majority of small stones (5 mm in diameter or less) will pass if you simply drink plenty of fluids each day. If conservative approaches have failed.

Surgery may be needed if a stone:

1. does not pass after a reasonable period of time

2. causes constant and intractable pain

3 Causes persistent nausea and vomiting, such that the patient is not able to tolerate food or liquid

4. is too large to pass on its own

5. blocks the flow of urine

6. causes ongoing urinary tract infection

7 harms the function of the kidney

Historically, the surgical removal of a kidney stone involved an operation with an incision and an often lengthy recovery time. Today, though, most stones can be treated in a minimally invasive, or even non-invasive, fashion. As a result, recovery times are now measured in days, not weeks.

Some of the treatments for kidney stones include:

Extracorporeal shock wave lithotripsy (ESWL®):
ESWL® Is the most frequently used procedure for eliminating kidney stones. Shock wave treatment uses a machine called a lithotripter, which works by directing ultrasonic or shock waves, created outside your body (“extracorporeal”) through skin and tissue, until they hit the dense kidney stones. The impact of the shock wave causes stress on the stone; the cumulative effect of repeated shock waves is one of increasing stress on the stone, until eventually the stone crumbles into small pieces. These small pieces, about the size of grains of sand, usually pass easily through the urinary tract, and are voided out in the patients urine. Shock wave lithotripsy is generally used when the stone is not excessively large, the kidney is functioning well, and there is no blockage to the passage of stone fragments. While shock wave lithotripsy is considered safe and effective, it can still cause complications. Most patients have blood in their urine for a few days after treatment. Bruising and minor discomfort in the back or abdomen from the shock waves are also common.

Ureteroscopy (URS):
Ureteroscopy involves the use of ureteroscopes, small flexible or semi-rigid telescopes that can be inserted up the urethra, through the bladder and into the ureter without an incision. These instruments allow the doctor to view a ureteral stone directly. They also have small working channels through which various devices can be passed to remove or fragment the stone. Anesthesia is generally used, and a stent is generally left in the ureter for a few days after treatment while healing takes place. The majority of ureteroscopic procedures can be performed as day surgery and most individuals can return to work within several days following the procedure.

Percutaneous nephrolithotomy (PNL).:

This procedure is the treatment of choice for patients with ureteral stones that are larger, are in a location that does not allow effective use of SWL, or cause a blockage so severe that they cannot be bypassed using stent.
In this procedure, the surgeon makes a tiny cut in the flank area and then uses an instrument called a ephroscope to locate and remove the stone. For larger stones, a type of energy probe (ultrasonic, electrohydraulic, hydraulic, laser, or pneumatic) may be needed to break the stone into small pieces. All of this is done while the patient is sedated or under anesthesia. One advantage of this procedure over SWL is that the surgeon removes the stone fragments instead of relying on their natural passage from the ureters. Generally, patients stay in the hospital overnight and may have a small catheter in the kidney and/or stent during the healing process. Most patients can resume light activity in one to two weeks.